Da Vinci Payer Data Exchange
2.0.0-ballot - ballot US

This page is part of the Da Vinci Payer Data Exchange (v2.0.0-ballot: STU2 Ballot) based on FHIR (HL7® FHIR® Standard) R4. The current version which supersedes this version is 2.1.0. For a full list of available versions, see the Directory of published versions

Resource Profile: PdexPriorAuthorization - Mappings

Draft as of 2022-02-18

Mappings for the pdex-priorauthorization resource profile.

Mappings for Workflow Pattern (http://hl7.org/fhir/workflow)

PdexPriorAuthorization
ExplanationOfBenefitEvent
   identifierEvent.identifier
   statusEvent.status
   typeEvent.code
   patientEvent.subject
   createdEvent.occurrence[x]
   entererEvent.performer.agent
   insurerEvent.performer.agent
   facilityEvent.performer.location

Mappings for FiveWs Pattern Mapping (http://hl7.org/fhir/fivews)

PdexPriorAuthorization
ExplanationOfBenefit
   identifierFiveWs.identifier
   statusFiveWs.status
   typeFiveWs.class
   subTypeFiveWs.class
   useFiveWs.class
   patientFiveWs.subject[x], FiveWs.subject
   billablePeriodFiveWs.done[x]
   createdFiveWs.recorded
   entererFiveWs.author
   insurerFiveWs.author
   providerFiveWs.source
   referralFiveWs.cause
   facilityFiveWs.where[x]
   claimFiveWs.why[x]
   careTeam
      providerFiveWs.actor
   item
      serviced[x]FiveWs.done[x]
      location[x]FiveWs.where[x]
   addItem
      providerFiveWs.source
      serviced[x]FiveWs.done[x]
      location[x]FiveWs.where[x]

Mappings for HL7 v2 Mapping (http://hl7.org/v2)

PdexPriorAuthorization
ExplanationOfBenefit
   priorityRequest.priority
   insuranceCoverage

Mappings for RIM Mapping (http://hl7.org/v3)

PdexPriorAuthorization
ExplanationOfBenefitEntity. Role, or Act
   meta
      idn/a
      extensionn/a
   textAct.text?
   containedN/A
   modifierExtensionN/A
   related
      idn/a
      extensionn/a
      modifierExtensionN/A
   payee
      idn/a
      extensionn/a
      modifierExtensionN/A
   careTeam
      idn/a
      extensionn/a
      modifierExtensionN/A
   supportingInfo
      idn/a
      extensionn/a
      modifierExtensionN/A
   diagnosis
      idn/a
      extensionn/a
      modifierExtensionN/A
   procedure
      idn/a
      extensionn/a
      modifierExtensionN/A
   insurance
      idn/a
      extensionn/a
      modifierExtensionN/A
   accident
      idn/a
      extensionn/a
      modifierExtensionN/A
   item
      idn/a
      extensionn/a
      modifierExtensionN/A
      adjudication
         idn/a
         modifierExtensionN/A
      adjudication (adjudicationamounttype)
         idn/a
         extensionn/a
         modifierExtensionN/A
      adjudication (allowedunits)
         idn/a
         extensionn/a
         modifierExtensionN/A
      adjudication (denialreason)
         idn/a
         extensionn/a
         modifierExtensionN/A
      adjudication (consumedunits)
         idn/a
         extensionn/a
         modifierExtensionN/A
      detail
         idn/a
         extensionn/a
         modifierExtensionN/A
         subDetail
            idn/a
            extensionn/a
            modifierExtensionN/A
   addItem
      idn/a
      extensionn/a
      modifierExtensionN/A
      detail
         idn/a
         extensionn/a
         modifierExtensionN/A
         subDetail
            idn/a
            extensionn/a
            modifierExtensionN/A
   adjudication
      idn/a
      extensionn/a
      modifierExtensionN/A
   adjudication (adjudicationamounttype)
      idn/a
      extensionn/a
      modifierExtensionN/A
   total
      idn/a
      modifierExtensionN/A
   payment
      idn/a
      extensionn/a
      modifierExtensionN/A
   processNote
      idn/a
      extensionn/a
      modifierExtensionN/A
   benefitBalance
      idn/a
      extensionn/a
      modifierExtensionN/A
      financial
         idn/a
         extensionn/a
         modifierExtensionN/A